Below is a discussion with Michelle Allison. Because I thought this was an interesting discussion from which I learned much, because I think Michelle is wrong, and because there are still some details to be worked out, I have challenged Michelle to a debate on my new podcast co-hosted with Avi Bitterman.

On this podcast, Avi and I will challenge individuals to debates who are prominent on social media in the nutrition science space. We will have a Challenge List that will provide for the reasons for these challenges, including posts documenting the reasons why we think the people that we are challenging are wrong, and why the challenge is important.

This is one of those posts.

To give context, Michelle Allison is a Health At Every Size advocate with 20K Twitter followers. She believes that trying to lose weight is psychologically harmful, for most people impossible, and does not provide any health benefit.

Others of her views can be found here:

https://twitter.com/search?q=from%3Afatnutritionist%20weight%20loss&src=typed_query

These views are not supported by the scientific research, which I have documented here: https://thedietwars.com/2019/12/04/long-term-weight-loss-prevents-death/

This is the context within which I am arguing against Michelle.

Without further ado, here is the discussion.

This tweet was intended as a quote-retweet to someone who encouraged clinicians to abandon BMI charts because of the potential damage to patients because of stigma. Here is the original tweet:

Here is a comment on this tweet.

I am not certain about why my quote-retweet did not work. But what followed, I think, remains interesting and informative regardless of that detail, because it amounts, if I am right, to a general principle regarding what kind of advocacy is acceptable and what kind is not from the standpoint of modern medical ethics.

Without further ado…

(It should be noted that SDoH means “social determinants of health”, which is the phrase used in the tweet by Haley Goodrich, indicating that Michelle was aware of the tweet to which mine was referring. In any case…)

Here Michelle is referring to the principle of non-maleficence, a mainstay in modern medical ethics, seen here:

Here is a part of the abstract of this paper.

In particular, some of the “stigmatizing messages” were:

These are clearly not BMI charts. This research in fact has nothing to do with the argument that Haley Goodrich was making or Michelle Allison was defending.

The crucial arguments (to me) and the main purpose of this post are as follows:

  1. Some clinical practices are weakly supported by evidence, such as the use of information on the relationship between BMI and health, yet there is good reason to believe that they promote health;
  2. These should be challenged and tested scientifically to confirm that they do indeed promote health;
    • Carefully testing current, weakly supported practices helps to avoid violating the ethical principle of non-maleficence, by eliminating practices that may be harmful;
  3. Practitioners should not be dissuaded from engaging in these practices without evidence, as doing so might withhold benefit or withhold otherwise useful information from patients;
    • Withholding information that may be beneficial to patients violates the ethical principles of beneficence as well as autonomy.

For completeness’s sake, arguments that Michelle made were as follows:

(I decided not to answer Michelle’s question because the answer was already in the links that I sent: several individual RCTs were discussed as well as a meta-analysis. I wrote that blog post precisely to address the claims of folks like Michelle.)

Argument #2

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Yet no response from Michelle to my counterargument. To be clear, Michelle is making the argument that the correlation between BMI and poor health outcomes is not actually from BMI itself but from other characteristics associated with high BMI. I made the point that many of those other characteristics (though not all) are caused by BMI itself, which is to some extent inherited.

Finally, after an initial bit of enthusiasm for the discussion, I grew a little tired of moving in circles, without any indication that Michelle was considering my arguments–instead, as one can see, the thread of discussion would just fall off and I was left to deal with new arguments. In debate, this is often called gish-gallop. There was a modest level of gish-gallop going on here, so I tweeted:

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Because this discussion was in combination fascinating and frustrating, I decided that I wanted to formally issue a challenge Michelle according to the Challenge List system that I am using for my upcoming Diet Wars podcast. I wanted to do this in order to inform Michelle that she would be added to the challenge list.

This seemed to upset Michelle. My reasoning was that instead of jumping around from topic to topic and dropping arguments, we could get some kind of resolution over voice. She didn’t see things this way:

To which I responded:

This got Michelle going in ways that were still further regrettable:

It is important for me to emphasize that my motivation for pursuing this discussion was that I find the advocacy of people like Michelle likely harmful for the care of patients. I have no personal animus toward Michelle. It is her views that I find objectionable and harmful.

Michelle believes that weight loss is harmful, difficult to achieve, and/or that there is no evidence to support that any benefits accrue to those achieving weight loss; she promotes these views to tens of thousands of followers. Most or all of these views conflict with scientific consensus, and virtually nobody in the scientific mainstream believes them.

Michelle has a larger following than me, and her influence is much greater than mine. I believe that these beliefs (and her promotion thereof) are harmful and in many cases, such as when encouraging healthcare practitioners not to seek weight loss for their patients, unethical. Thus, I feel that it was important to push back and challenge what I believe is a harmful and unethical.

Furthermore, I believe that Michelle cannot support these beliefs with evidence or well-reasoned arguments. This post and the open challenge to Michelle for a discussion are intended to document the reasons for this belief on my part, in the hope that others can see how potentially problematic Michelle’s beliefs are from an ethical standpoint.

Other similar such challenges to individuals who reject science, as Michelle does, will be forthcoming in the coming months. It is not a “social dominance ritual”, except insofar as I believe that evidence and reasonable positions should be the socially dominant ones. I take some risk in posting this, and in particular openly posting my own mistakes in this exchange. I take this risk because I believe this is an important issue, and because I believe that it is important to highlight that Michelle Allison, one of the most prominent HAES advocates on Twitter, cannot seem to support her own positions when subjected to critical scrutiny, positions that if adopted by her followers, could lead to worse health and potentially result in an earlier death.

Regardless of the bad blood that this exchange engendered, I learned a great deal through the formal arguments exchanged, which apply to much that is argued by HAES advocates–in particular, these arguments impugn the claim that weight loss should not be sought by clinicians–but more broadly as well.

In particular, it seems clear to me that without good evidence to suggest otherwise, Internet gurus who tell patients to forego important medical treatments are violating the ethical principle of beneficence and might in theory be subject to penalties from their pertinent licensing boards. I think this is a very important argument that I have extracted from this.

To re-state, the crucial arguments (to me) are as follows:

  1. Some clinical practices are weakly supported by evidence, such as the use of information on the relationship between BMI and health, yet there is good reason to believe that they promote health;
  2. These should be challenged and tested scientifically to confirm that they do indeed promote health;
    • Carefully testing current, weakly supported practices helps to avoid violating the ethical principle of non-maleficence, by eliminating practices that may be harmful;
  3. Practitioners should not be dissuaded from engaging in these practices without evidence, as doing so might withhold benefit or otherwise useful information from patients;
    • Withholding information that may be beneficial to patients violates the ethical principles of beneficence as well as autonomy.

If you disagree with these arguments, I would love to know your opinion. Posts that are aggressive or do not engage with the arguments will be removed.



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